Blood Loss and Transfusion After Topical Tranexamic Acid Administration in Primary Total Knee Arthroplasty

Abstract

There has been much debate and controversy about the safety and efficacy of the topical use of tranexamic acid in primary total knee arthroplasty (TKA). The purpose of this study was to perform a meta-analysis to evaluate whether there is less blood loss and lower rates of transfusion after topical tranexamic acid administration in primary TKA. A systematic review of the electronic databases PubMed, CENTRAL, Web of Science, and Embase was undertaken. All randomized, controlled trials and prospective cohort studies evaluating the effectiveness of topical tranexamic acid during primary TKA were included. The focus of the analysis was on the outcomes of blood loss results, transfusion rate, and thromboembolic complications. Subgroup analysis was performed when possible. Of 387 studies identified, 16 comprising 1421 patients (1481 knees) were eligible for data extraction and meta-analysis. This study indicated that when compared with the control group, topical application of tranexamic acid significantly reduced total drain output (mean difference, -227.20; 95% confidence interval, -347.11 to -107.30; P<.00001), total blood loss (mean difference, -311.28; 95% confidence interval, -404.94 to -217.62; P<.00001), maximum postoperative hemoglobin decrease (mean difference, -0.73; 95% confidence interval, -0.96 to -0.50; P<.00001), and blood transfusion requirements (risk ratios, 0.33; 95% confidence interval, 0.24 to 0.43; P=.14). The authors found a statistically significant reduction in blood loss and transfusion rates when using topical tranexamic acid in primary TKA. Furthermore, the currently available evidence does not support an increased risk of deep venous thrombosis or pulmonary embolism due to tranexamic acid administration. Topical tranexamic acid was effective for reducing postoperative blood loss and transfusion requirements without increasing the prevalence of thromboembolic complications.

Tranexamic acid reduces hidden blood loss in the treatment of intertrochanteric fractures with PFNA: a single-center randomized controlled trial

“…Our results showed that compared to NS, TXA administration reduced postoperative RBC loss to 279.35 mL and hidden blood loss to 700.3 mL (assuming 30% hematocrit) in patients with intertrochanteric fractures. These results are consistent with previous studies reporting on total knee arthroplasty [ 12 ], periacetabular osteotomy [ 11 ], extracapsular fracture of the hip [ 13 ], and total shoulder arthroplasty [ 16 ]. Our data also suggests that TXA administration has the potential to decrease the number of orthopedic patients requiring transfusion; administration of 1 g of TXA decreased the transfusion rate from 56.09 to 28.20%.…”

Peri-articular tranexamic acid injection in total knee arthroplasty: a randomized controlled trial

“…However, there are reports of thrombus formation associated with IV TXA [ 16 , 17 ]. Topical TXA applications have been reported as another method to reduce blood loss and are associated with fewer systemic side effects compared to IV TXA [ 6 , 7 , 18 – 21 ]. Topical TXA is usually applied by soaking TXA in the operating field and washed after period of time or left to drain out following wound closure and drain insertion.…”

Factors that influence blood loss and need for transfusion following total knee arthroplasty

“…While TXA is known to be effective, patients with thromboembolic events and conditions often contraindicate its administration (35,40). Topical application of TXA is perhaps as effective as intravenous administration, and is not contraindicated (35,(43)(44)(45). Erythropoietin is an effective means of increasing preoperative Hb, but may not be cost effective (13).…”